Clinically Relevant Myocardium Segmentation in Cardiac Magnetic Resonance Images

Deep learning approaches have shown great success in myocardium region segmentation in Cardiac MR (CMR) images. However, most of these often ignore irregularities such as protrusions, breaks in contour, etc. As a result, the common practice by clinicians is to manually correct the obtained outputs for the evaluation of myocardium condition. This paper aims to make the deep learning systems capable of handling the aforementioned irregularities and satisfy desired clinical constraints, necessary for various downstream clinical analysis. We propose a refinement model which imposes structural constraints on the outputs of the existing deep learning-based myocardium segmentation methods. The complete system is a pipeline of deep neural networks where an initial network performs myocardium segmentation as accurate as possible and the refinement network removes defects from the initial output to make it suitable for clinical decision support systems. We experiment with datasets collected from four different sources and observe consistent final segmentation outputs with improvement up to 8% in Dice Coefficient and up to 18 pixels in Hausdorff Distance due to the proposed refinement model. The proposed refinement strategy leads to qualitative and quantitative improvements in the performances of all the considered segmentation networks. Our work is an important step towards the development of a fully automatic myocardium segmentation system. It can also be generalized for other tasks where the object of interest has regular structure and the defects can be modelled statistically.